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AGE: ____________________ GRADE: _______________

GENDER: ____________________ SECTION: ____________________


Bullying is when a bully teases, threaten and inflict physical or emotional harm upon a weaker


1. Have you ever seen/witnessed a person being bullied before?

 NO
2. If yes, was she/he you’re...
 Friend
 Sister/Brother
 Classmate
 Schoolmate
 Others (Pls. Specify).__________________________________
3. What did you do after seeing someone being bullied?
 I ignored it.
 I helped the person.
 I have never seen someone being bullied.
 I told my parents about it.
 I told my teachers about it.
 I told another student about it.
 I joined the bullies.
4. What was the reason ‘IF’ you did not do anything the last time you saw someone being
 I don’t want to get involved.
 I was afraid.
 I didn’t want to get in trouble for telling.
 The bullying wasn’t so bad.
 The person being bullied deserved it.
 It was not my business /problem.
 I have never seen someone being bullied.
 Others (Please specify).___________________________________
5. If you ever witness someone being bullied again, what will you do then?
 I will still ignore it.
 I will help her/him.
 I will tell the teachers about it.
 I will still join the bullies.
 I will still think that it’s not my problem.
 Others (Please specify).___________________________________


1. Have you ever bullied someone before?

 Yes, and I regret it.
 Yes, and I don’t regret it.
 I have never bullied someone before.
2. What was your reason for bullying someone?
 Just for fun.
 I was bullied before that’s why I want to be the bully right now.
 I want attention because my family can give it to me.
 I think it’s cool.
 I don’t want to feel weak and loser.
 I have never bullied someone.
 Others (Please specify).___________________________________
3. How often do you bully someone?
 Just once.
 Just twice
 Many times
 Countless times
 Others (Please Specify).__________________________________
4. Would you still bully someone?
 Yes
 No


1. Were/Are you, yourself a victim of bullying?

 Yes
 No
2. If yes , were you bullied…
 Physically (Pushed, slapped, kicked , punched, hit, shoved, etc.)
 Emotionally (Cursed at, laughed about, mocked, any forms of verbal abuse, etc.)
 Socially (Excluded from a group, treating you like invisible, rumours, etc.)
 Cyber (Bullied using social media)
 Gender (Being gay, lesbian, etc.)
 Others (Please Specify)._______________________________________________
3. How often do they bully you and the others?
 Not once.
 Once or twice.
 Every week .
 Many times..
4. If someone will bully you again, what will you do then?
 I will fight back physically.
 I will fight back through telling the teachers.
 I will still let them bully me.
 I will ignore them.
 I will tell my friend about it.
 I will tell my parents about.
5. What is the feeling of being bullied?
(Please provide an answer)

6. If you are given a chance to talk to a bully, what will you say?
(Please provide an answer)